Campbell, I.R., & Illingworth, M.H. (1992). Can patients wash during radiotherapy to the breast or chest wall? A randomized controlled trial. Clinical Oncology, 4, 78–82.

To examine the controversy regarding washing the skin during or after a course of radiation therapy (RT)

Participants were randomized to one of three washing policies: (a) not washing, (b) washing with water alone, or (c) washing with soap and water. Assessment of skin reactions was weekly during treatment and at two and four weeks after treatment was completed.

• The study sample (N = 95) was comprised of female patients.
• Age ranged from 33–75 years.
• All patients were receiving postoperative RT following breast local excision or mastectomy.
• Prescribed doses were 4,500 cGy or 4,700 cGy in 20 fractions in 28 days.

The study took place at Mercy Clatterbridge Hospital in Bebington, Mercyside, United Kingdom.

The study used a randomized controlled trial design.

• Patients graded their symptoms or itching and pain in the treated skin as none (0) to severe (3).
• Skin was graded according to the European Organization for Research and Treatment of Cancer/Radiation Therapy Oncology Group (EORTC/RTOG) Scale from 0 (none) to 3 (severe).
• Desquamation was scored as none (0), dryness of the skin (1), moderate flaking (2), severe flaking (3) or patchy moist desquamation (4).

Itching was the main local symptom experienced; it was present at some point in 77% of the patients. In all groups the average itching score rose progressively during treatment, with a maximum at four weeks after starting treatment. Participants randomized to washing had itching scores either similar to or less than those not washing. Several of the comparisons showed a statistically significant reduction in itching at p < 0.05 with washing. Pain in the treated skin was reported by 31% of participants during the observation period. No clear trends were observed in the different washing policy groups. The average scores for erythema rose progressively during observation with a maximum at four to six weeks. There was little difference between washing groups, and a small trend for the non-washing groups to have the highest reactions. Several comparisons showed a statistically significant reduction in erythema associated with washing (p < 0.05). Average scores for desquamation showed maximum reactions at six to eight weeks after starting treatment. Patients who were washing had markedly lower scores than patients who were not washing, with some comparisons reaching statistical significance (p < 0.05 washing compared with p < 0.01 not washing).

Findings support allowing patients to wash during RT with either soap and water or water alone.

• Generalization of findings is not completely clear.
• Approximately half of the participants were prescribed a topical cream for their skin reaction (n = 45), and whether the cream had any effect on study findings is not clear.
• No restriction was placed on the frequency of washing in any of the groups.